312700033-9-12-2024-59-AS-MSEY-D99S4P-20240919133300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700033
Report Date: 09/12/2024
Date Signed: 09/12/2024 03:24:04 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/23/2024 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20240723114956

FACILITY NAME:	GRANITE BAY COUNTRYHOUSE LLC		FACILITY NUMBER:	312700033
ADMINISTRATOR:	JAMES HALL		FACILITY TYPE:	740
ADDRESS:	8485 BARTON RD		TELEPHONE:	(916) 899-6565
CITY:	GRANITE BAY	STATE: CA	ZIP CODE:	95746
CAPACITY:	49	CENSUS: 29	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	James Hall		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility is malodorous
Staff did not meet residents' needs

INVESTIGATION FINDINGS:

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LPA Parks and LPA Mikkelson arrived on Thursday September 12, 2024, to conclude a complaint investigation regarding the above allegations.

LPA met with Administrator James Hall and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator, Director of Nursing, and staff. LPA and Administrator toured resident apartments and common areas. The result of the investigation is as follows:

Allegation: Facility is malodorous
On the initial complaint facility visit, on July 26, 2024, LPA Parks and Administrator Hall toured the facility together. LPA inspected 5 apartments whose occupants incontinence needs were provided by staff. LPA did not observe any odor in the resident apartments. Furthermore, LPA Parks and Administrator Hall toured the common areas of the facility, and no odor was detected.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240723114956

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GRANITE BAY COUNTRYHOUSE LLC	FACILITY NUMBER: 312700033
	VISIT DATE: 09/12/2024

NARRATIVE

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Allegation: Staff did not meet residents’ needs
LPA Parks interviewed staff who stated there have always been 2 staff members to provide care and supervision for the overnight shift. LPA Parks reviewed staffing schedules which corroborate that there are at least 2 staff on the NOC shift. No staff interviews acknowledged that there have been any shifts were a sole staff member is at the facility to provide care and supervision for all staff.

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was provided to the facility.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Melissa Parks	TELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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